Provider Demographics
NPI:1386841179
Name:NEEL, DARRELL MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:MARK
Last Name:NEEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BOWIE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4012
Mailing Address - Country:US
Mailing Address - Phone:903-927-1500
Mailing Address - Fax:903-927-2077
Practice Address - Street 1:402 W BOWIE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4012
Practice Address - Country:US
Practice Address - Phone:903-927-1500
Practice Address - Fax:903-927-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist